目的 将预防腹腔镜手术患者术中非计划性低体温的最佳证据应用于临床并评价其效果,为临床医护人员提供参考.方法 根据最佳证据,制订8条审查指标并开展证据应用.证据应用前后各纳入腹腔镜手术患者 30 例及 40 名手术室护士作为研究对象,比较最佳证据应用前后腹腔镜手术患者术中非计划性低体温的发生率、手术室护士对腹腔镜手术患者术中非计划性低体温的预防及管理的认知水平以及手术室护士依据证据采取预防低体温措施的执行率.结果 证据应用后,通过临床审查,腹腔镜手术患者术中非计划性低体温的发生率由证据应用前的33.3%降至证据应用后的 10.0%,手术室护士对腹腔镜手术患者术中非计划性低体温的预防及管理的认知水平合格率由证据应用前的 62.5%上升至证据应用后的 95.0%.证据应用前,对审查指标 6的执行率为90.0%,审查指标7的执行率为 70.0%,其余审查指标的执行率均在70.0%以下;最佳证据应用后,审查指标1、2、3、4、5、7、8的执行率均有明显提高,与应用前比较,差异具有统计学意义(P＜0.05).结论 预防腹腔镜手术患者术中非计划性低体温最佳证据的临床应用可降低患者术中非计划性低体温的发生率,提高手术室护士对腹腔镜手术患者术中非计划性低体温的预防及管理的认知水平及依据证据采取预防低体温措施的执行率.

Pregnancy complicated with acute aortic dissection is rare and the mortality rate is high. The author reviewed the intraoperative nursing plan of a patient with aortic dissection in the third trimester of pregnancy who underwent Bentall operation and cesarean section, and introduced the evidence-based methods of preoperative nursing and nursing measures to prevent the complications that may occur in the perioperative period. Including preoperative preheat preservation, prevention of perioperative pressure injury, postoperative observation of cesarean section, intraoperative temperature regulation of Bentall, which can provide a reference for the clinical nursing measures of similar patients.

Background: This study sought to implement evidence-based nursing practices for patients undergoing laparoscopy surgery to prevent unplanned hypothermia, to develop review indicators for evidence-based nursing practices, and to analyze obstacles and contributing factors. Methods: Using the Joanna Briggs Institute health care model as the evidence-based theoretical framework, clinical problems were identified, evidence was systematically researched, evaluated and summarized, an index and method of examination was established, and quality items were examined. According to the results of the baseline review, the obstacles and promoting factors were analyzed, and methods and countermeasures were developed. Results: This study summarized 15 pieces of best evidence in relation to the following 5 aspects: risk assessment, body temperature monitoring, ambient temperature, passive insulation, and active insulation. There were 11 quality review indicators, only 4 of which had compliance rates of 100%. The main obstacle factors were a lack of nursing norms and operating procedures, a lack of information, and a lack of motivation among nursing staff. Conclusions: Based on the best evidence and the professional judgment of clinical staff, the quality review index is scientific and implementable. In the application of this clinical evidence, obstacles and other factors should be solved to promote the transformation of evidence.

目的:探讨以Logistic回归模型为基础制订护理方案预防神经外科患者术中获得性压力性损伤的效果.方法:选取2016年3月1日～2021年3月31日收治的神经外科患者80例,随机分为观察组和对照组各40例;对照组给予常规护理,观察组给予基于Logistic回归模型制订的护理方案.比较两组术中获得性压力性损伤发生率和满意度情况.结果:观察组术中获得性压力性损伤发生率、皮肤压红发生率均低于对照组(P<0.05);观察组总满意度高于对照组(P<0.05).结论:以Logistic回归模型为基础制订护理方案能预防神经外科患者术中获得性压力性损伤的发生,并提高患者满意度.

目的 探讨体位调整联合加压冲洗对腹腔镜卵巢子宫内膜异位囊肿剥除术中冲洗效果的影响.方法 选取全身麻醉下行腹腔镜卵巢子宫内膜异位囊肿剥除术的66例患者作为研究对象,采用随机数字表法分为对照组和观察组,每组33例.对照组给予1 000 mL生理盐水于头低脚高30.体位下常规冲洗,观察组在对照组冲洗基础上予以冲洗体位调整,且全程加压冲洗.检测并比较2组患者气腹建立完成后(干预前)、冲洗结束后(干预后)腹腔液糖类抗原125(CA125)、血管内皮生长因子(VEGF)水平.结果 干预前,2组腹腔液CA125、VEGF水平比较,差异均无统计学意义(P＞0.05);干预后,2组腹腔液CA125、VEGF水平均低于干预前,且观察组低于对照组,差异有统计学意义(P＜0.05);观察组干预前后腹腔液CA125、VEGF水平差值均大于对照组,差异有统计学意义(P＜0.05).结论 在腹腔镜卵巢子宫内膜异位囊肿剥除术中采用体位调整联合加压冲洗,可降低腹腔液CA125、VEGF水平,减少盆腔中脱落的内膜细胞残留,降低内膜细胞扩散种植的概率.

BACKGROUND:This study aimed to search, analyze, and summarize relevant evidence for the prevention of unplanned hypothermia in patients undergoing laparoscopic surgery, so as to reduce the incidence of unplanned hypothermia in patients undergoing laparoscopic surgery and provide a reference for clinical medical staff.METHODS:According to the evidence pyramid model, relevant literature were retrieved by computer in databases. Literature quality evaluation and the evidence grading system of the Australian JBI Evidence-Based Health Care Centre Evidence Recommendation Rating System were used to evaluate the literature quality and determine the level of evidence. The time limit for retrieval was from the establishment of the databases to March 31, 2021.RESULTS:A total of 12 studies were included in this study. Of these, 5 evidence items were finally extracted, and 15 pieces of best evidence were summarized, including the risk assessment of hypothermia in patients undergoing laparoscopic surgery, temperature monitoring, ambient temperature, passive insulation measures, and active insulation measures.CONCLUSIONS:The evidence for the prevention of unplanned hypothermia in patients undergoing laparoscopic surgery provided evidence-based approaches for reducing the incidence of intraoperative hypothermia for clinical staffs. It is suggested that the cultural characteristics of China, medical resources, and patients' own conditions should be considered when applying the evidence.

目的 探讨降温贴在预防腹腔镜直肠癌根治术骶尾部压力性损伤中的应用效果.方法 将60例腹腔镜直肠癌患者随机分为对照组和实验组各30例,对照组摆放体位时骶尾部采用常规软垫,实验组摆放体位时采用常规的软垫基础上在骶尾部贴降温贴,比较两组患者体温、骶尾部皮肤温度、皮肤压红面积.结果 对照组和实验组肛温差异无统计学意义(P>0.05),实验组患者骶尾部皮肤温度低于对照组、实验组皮肤压红面积小于对照组,统计学有显著差异(P<0.05).结论 对腹腔镜直肠癌患者的骶尾部采用降温贴进行皮肤保护,是一种有效预防手术患者骶尾部压力性损伤的护理方法.

目的:探讨自制Y型烟雾吸引管在腹腔镜全子宫切除术中,吸除电外科设备使用时产生手术烟雾的效果.方法:选择2018年6月1日～2019年8月31日期间,在全麻下行腹腔镜全子宫切除手术患者80例,按患者住院号分为观察组和对照组各40例;观察组术中使用自制Y型烟雾吸引管吸除手术烟雾,对照组使用传统方法进行排烟;比较两组除烟效果及医生满意度.结果:观察组术中镜头擦拭次数、排烟次数、手术时间均少于对照组(P<0.05),医生对气腹压力稳定度、镜头清晰度、排烟效果的满意例数均多于对照组(P<0.05).结论:自制Y型烟雾吸引管能有效吸除手术烟雾,保证手术顺利进行,改善手术室环境,提高医务人员对手术烟雾的主动防护意识,使用方便,成本低廉,值得在临床上推广使用.

目的 探讨泡沫敷料联合芦荟凝胶在预防腹腔镜直肠癌根治术骶尾部压力性损伤中的应用效果.方法 选择2016年1月起在苏州市立医院本部外科住院并行腹腔镜直肠癌根治手术的60例患者,按照奇偶数随机法分为对照组和试验组各30例.对照组摆放体位前骶尾部采用泡沫敷料,试验组摆放体位前在骶尾部涂抹芦荟凝胶后贴泡沫敷料.比较两组患者术后即刻的皮肤压红面积及术后压红消退时间.结果 两组患者皮肤压红面积的分布差异无统计学意义(Z=-0.173,P=0.863);试验组压红消退时间显著小于对照组(Z=-3.338,P=0.001).结论 对腹腔镜直肠癌根治术患者的骶尾部涂抹芦荟凝胶后贴泡沫敷料进行皮肤保护,术毕压红消退时间明显加快,是一种有效预防手术患者骶尾部压力性损伤的护理方法.

芦荟作为一种传统的常用中药,具有悠久的药用历史,无论是传统医学还是现代医学,都对芦荟的药用价值给予了高度肯定.本文就以芦荟在现代医学中的药理作用以及临床应用两方面加以综述.